A new metastudy has affirmed the link between gum disease and hypertension, finding the worse a person’s oral health the greater their risk of suffering from high blood pressure. The direction of the relationship remains unclear with researchers unsure whether improved dental treatment can directly influence blood pressure.
The meta-analysis gathered data from 81 studies spanning 26 countries, and the conclusions confirmed what a great deal of prior work had suggested. A positive linear relationship was detected between periodontitis, or gum disease, and risk of high blood pressure. While moderate periodontitis could be associated with a 22 percent greater risk of hypertension, severe periodontitis was linked to a 49 percent greater chance of the condition.
“We observed a linear association – the more severe periodontitis is, the higher the probability of hypertension,” explains senior author Francesco D'Aiuto, from University College London. “There seems to be a continuum between oral health and blood pressure which exists in healthy and diseased states.”
While the metastudy’s conclusions are reasonably definitive, a number of questions remain unanswered surrounding exactly what mechanism is underpinning this association, and whether actively treating periodontitis can result in blood pressure reductions.
The metastudy included 12 intervention trials examining relationships between periodontal treatment and blood pressure but the results were decidedly inconclusive. Only five of those intervention trials showed gum disease treatments leading to improvements to arterial blood pressure.
“The evidence suggesting periodontal therapy could reduce blood pressure remains inconclusive. In nearly all intervention studies, blood pressure was not the primary outcome,” says D'Aiuto. “Randomized trials are needed to determine the impact of periodontal therapy on blood pressure.”
A number of mechanisms to explain the association are hypothesized by the researchers. One suggestion is that periodontitis can be mediated by similar inflammatory causes that also affect endothelial function. So, if this hypothesis were true, then treating severe periodontitis could reduce systemic inflammation and have a beneficial impact on hypertension.
Another hypothesis is that bacteria in the oral microbiome can play a role in periodontitis, and also cause some kind of vascular dysfunction. This hypothesis is intriguingly supported by recent research finding bacteria in the mouth can produce molecules that are swallowed and subsequently affect blood pressure.
Of course, the researchers suggest more work is needed to better understand the causal connection at play, but in the short term the study suggests oral health may be a useful biomarker to identify patients at risk of hypertension.
“The findings suggest that patients with gum disease should be informed of their risk and given advice on lifestyle changes to prevent high blood pressure such as exercise and a healthy diet,” says D'Aiuto.
The new study was published in the journal Cardiovascular Research.
Source: European Society of Cardiology
